First Name*
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Last Name*
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Email*
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Day Phone
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Home/Cell Phone
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Address1
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Address2
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City
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State*
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Zip Code
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How did you hear about us?
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Why are you considering equipment for you home? (please select
all that apply)
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Please list the names, age and gender of the people who will
use the equipment
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What are your/their goals? (please select all that apply)
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Other goals (if selected other above)
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What physical limitations or health issues do you have, if
any? (please select all that apply)
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Other limitations (if selected other above)
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Have you asked your doctor if you may begin a fitness program?
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What equipment do you own now?
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Where do you train now?
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I am specifically looking for the following equipment (please
select all that apply)
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Other Equipment (If selected above)
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Please describe any equipment you've already tried but don't
own. What did you like/not like about it?
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Describe the space you have for equipment. Please list dimensions
and other items such as furniture in the room.
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How soon would you like to get started?
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What is your budget?
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Any Other Comments? Please enter them below!
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